Infusion devices and methods

ABSTRACT

Medical devices, systems, and methods related thereto a glucose monitoring system having a first display unit in data communication with a skin-mounted assembly, the skin-mounted assembly including an in vivo sensor and a transmitter. The first display unit and a second display unit are in data communication with a data management system. The first display unit comprises memory that grants a first user first access level rights and the second display unit comprises memory that grants a second individual second access level rights.

BACKGROUND OF THE INVENTION

A variety of medical devices are employed to monitor a health condition.For example, devices include those designed to enable a user to manage ahealth condition based at least in part on the level of analyte in thebody. These types of devices include analyte determination devices, drugdelivery devices, and the like.

Such analyte devices have become widely used in recent years for peoplewith diabetes. Diabetics have typically measured their blood glucoselevel by lancing a finger tip or other body location (i.e., alternatesite) to draw blood, applying the blood to a disposable test strip in ahand-held meter and allowing the meter and strip to perform anelectrochemical test of the blood to determine the current glucoseconcentration. Such discrete or individual, in vitro tests are typicallyconducted at least several times per day. Detailed descriptions of suchglucose monitoring systems and their use are provided in U.S. Pat. No.7,058,437, issued to TheraSense, Inc., on Jun. 6, 2006, which isincorporated by reference herein in its entirety.

In vivo glucose monitoring devices are designed to provide continuousglucose monitoring. Some of these continuous systems employ adisposable, transcutaneous sensor that is inserted into the skin tomeasure glucose concentrations in interstitial fluid. A portion of thesensor protrudes from the skin and is coupled with a durable controllerand transmitter unit that is attached to the skin with adhesive. Awireless handheld unit is used in combination with the skin-mountedtransmitter and sensor to receive glucose readings periodically, such asonce a minute. At a predetermined time interval, such as every three,five or seven days, the disposable sensor is removed and replaced with afresh sensor which is again coupled to the reusable controller andtransmitter unit. With this arrangement, a person with diabetes maycontinuously monitor their glucose level with the handheld unit. Thehandheld unit of the in vivo system can also include an in vitro teststrip meter for conducting individual tests as described above. The invitro test strip meter can be used to calibrate the continuousmonitoring system each time a new in vivo sensor is implanted.Additionally, the in vitro test strip meter can be used as back up incase the in vivo system fails, a new sensor is equilibrating, or whenthe transmitter must be turned off, such as during takeoffs and landingswhen aboard an airliner. Detailed descriptions of such a continuousglucose monitoring system and its use are provided in U.S. Pat. No.6,175,752, which is incorporated by reference herein in its entirety.

Drug delivery devices, including wholly implantable infusion pumps andpumps that infuse drug through a transcutaneously placed fluid channelsuch as flexible tubing, are devices that enable the controllableadministration of a drug to a user. Pumps may be under the control orsemi-control of a healthcare monitoring device or may be controlled bythe user. Examples of such include insulin pumps used by diabetics toadminister insulin for glucose control.

The purpose of in vitro or in vivo glucose monitoring, and insulindelivery devices, is to assist people with diabetes in keeping theirblood glucose within a predetermined range. If a person's blood glucoselevel rises too high, hyperglycemia can occur. The short term effects ofhyperglycemia can include fatigue, loss of cognitive ability, moodswings, excessive urination, excessive thirst and excessive hunger. Ofmore immediate concern, if a person's blood glucose level drops too low,hypoglycemia can occur. Like hyperglycemia, symptoms of hypoglycemiaalso include fatigue and loss of cognitive ability. If unchecked,however, hypoglycemia can quickly lead to loss of consciousness or coma.Some diabetics have little or no symptoms of hypoglycemia, or find itdifficult to distinguish between symptoms of hyperglycemia andhypoglycemia. Long term effects of not keeping blood glucose levelswithin a proper range include health complications such ascardiovascular disease, chronic renal failure, retinal damage which canlead to blindness, nerve damage, impotence, and gangrene with risk ofamputation of toes, feet, and even legs. Clearly, proper glucosemonitoring and corrective action based on the monitoring is essentialfor people with diabetes to maintain their health.

Also of importance is compliance to a glucose monitoring regime.Compliance may be particularly difficult with persons who requiresupervision, e.g., young children or mentally impaired individuals.Compliance may include strict adherence to healthcare provider and/orcaregiver provider instructions. If healthcare instructions change, itis necessary that the user be timely notified of such changes. Likewise,it is important that instructions be readily available in case a personneeds to be reminded thereof.

SUMMARY OF THE INVENTION

Before summarizing the invention, it is to be understood that theinvention is applicable to in vitro analyte monitoring devices, in vivoanalyte monitoring devices, and a drug infusion devices. Unlessotherwise indicated, specific reference herein to only one of suchdevices is only for the sake of brevity and not intended to limit thescope of the invention. Furthermore, the subject invention is describedprimarily with respect to glucose monitoring devices and insulininfusion pumps, where such descriptions are not intended to limit thescope of the invention. It is to be understood that the subjectinvention is applicable to any suitable analyte monitoring device anddrug infusion device.

According to aspects of some embodiments of the present invention, amedical device (in vitro analyte monitoring device, in vivo analytemonitoring device, drug infusion device) is provided with alertfeatures. These alert features assist a user in maintaining properanalyte levels. Blood glucose is one of many analytes that may bemaintained using aspects of the present invention. For each user, anideal or target analyte range can be established. Above and below thisideal range, upper and lower ranges of moderate concerns, respectively,can also be established. Above the upper range of moderate concern, anupper range of high concern can be established. Similarly, below thelower range of moderate concern, a lower range of high concern can alsobe established. By way of example, a user can make in vitro bloodglucose measurements, such as with a handheld meter and test strip. Insome embodiments of the invention, the user can be alerted by the testmeter when a measurement falls within either of the upper or lowerranges of moderate concern. The alert may indicate to the user which ofthe upper and lower ranges of moderate concern the measurement fallsinto.

According to other aspects of the invention, a medical device (in vitroanalyte monitoring device, in vivo analyte monitoring device, druginfusion device) is provided with alarm features. These alarm featuresalso assist a user in maintaining a proper analyte (e.g., blood glucose)level. As described above, upper and lower blood glucose ranges of highconcern can be established. In some embodiments of the invention, a testmeter can be provided with alarms that warn the user when a measurementfalls within either of the upper or lower ranges of high concern.Preferably, the alarm indicates to the user which of the upper and lowerranges of high concern the measurement falls into. Additionally, it ispreferable that the alarms indicate a higher level of urgency than dothe previously described alerts. Note that a user's analyte level maypass from an ideal range, through a range of moderate concern and into arange of high concern before the user conducts an analyte measurement.In such cases, the user may be provided with an alarm without receivingan alert first.

According to other aspects of the invention, an analyte monitoringsystem is provided with reminder features. The reminder features alsoassist a user in maintaining a proper analyte (e.g., glucose) level.Analyte ranges of moderate or high concern can be established, asdescribed above. In some embodiments of the invention, a test meter canhave a reminder feature that is triggered when a measurement value fallsinto a range of moderate or high concern. The reminder can prompt theuser after a predetermined period of time to take another analytemeasurement to ensure that the analyte level is heading toward or hasreturned to the ideal range. Such a reminder feature can be particularlyhelpful since it frees the user from either trying to remember when toretest or from setting an external alarm, if available. For those usersthat require supervision, such as children, the reminder featureautomatically assists the caregiver by providing the user with a retestreminder, even when the caregiver is not present to perform the task ofreminding.

According to various aspects of the invention, the above-describedalerts, alarms and reminders can be conveyed to the user visually, suchas with a graphical user interface (GUI) or light emitting diode(s)(LED). In one embodiment of the invention, a fixed-segment liquidcrystal display (LCD) is used as the GUI, with the value of the analytemeasurement appearing in flashing numerals when not in the ideal range.In addition, or in an alternative embodiment, up and down arrow iconscan be provided to display when an analyte measurement is in the upperor lower range of moderate and/or high concern. For example, a solidarrow icon can be displayed when the level is in the range of moderateconcern, and a flashing arrow can be displayed when the level is in therange of high concern. Different icons can be used depending on whetherthe level is in the range of moderate or high concern. For instance, anarrow icon having a first size can be displayed when the analyte levelis in the range of moderate concern, and a larger or verticallydisplaced arrow icon can be displayed when the level is in the range ofhigh concern. Alternatively, a horizontal arrow can be displayed whenthe analyte level is in the ideal range, an arrow inclined upward ordownward can be displayed when the level is in the upper or lower rangeof moderate concern, respectively, and an arrow inclined at a steeperupward or downward angle can be displayed when the level is in the upperor lower range of high concern, respectively. Alternatively, theopposite directions of the above arrows can be used to be indicative ofthe course of action to be taken rather than whether the current levelis high or low. For instance, a high analyte level may display adownward pointed arrow to indicate that the user should lower his or heranalyte level. In other embodiments, symbols such as +, − and = can beused to indicate high, low and on track readings, respectively. The useof a dot matrix display instead of or in combination with a fixedelement display may be employed, e.g., to allow for more flexibility inproviding alerts and/or alarms and/or reminders to a user. Text may beshown on the display, with or without accompanying icons, and with orwithout user feedback, to provide information to the user about aparticular alert, alarm and/or reminder. For example, after a testresult falling into a range of concern, text may appear explaining thesignificance of the results, proposing one or more courses of action,and/or indicating that the user should re-test after a certain period oftime. After such a period of time has elapsed, a further text messagemay appear which may include instructions to conduct further tests. Sometext messages may be downloaded or otherwise activated as part of aprescription from a Health Care Provider.

To reduce size and/or cost of a meter, one or more LEDs may be used toconvey an alert, alarm or reminder to a user. For instance, a single LEDcan be illuminated when the analyte measurement is not in the idealrange. The LED can be solid when in the range of moderate concern, andflashing when in the range of high concern. Different colors in one ormore LEDs can indicate different ranges. For instance green can indicatethe analyte level is in the ideal range, yellow can indicate the levelis in a range of moderate concern and red can indicate the level is in arange of high concern. Two LEDs can be used to indicate whether thevalue is high or low (or whether the user's analyte level should beraised or lowered). Three LEDs can be used, for instance with a firstLED indicating an analyte level below the ideal range, a second LEDindicating a level in the ideal range, and a third LED indicating alevel above the ideal range. Four LEDs can be used to indicate ananalyte level in the lower range of high concern, the lower range ofmoderate concern, the upper range of moderate concern and the upperrange of high concern, respectively. A fifth LED can be added toindicate a level in the ideal range.

In addition to or instead of visual indicators of alerts, alarms andreminders, a glucometer constructed according to aspects of the presentinvention can incorporate audible or physical feedback. Since diabetescan adversely affect a person's eyesight, such forms of user interfacecan become necessary. In one embodiment of the invention, a meter canemit an audible tone to indicate an analyte reading that is outside ofthe ideal range. A high tone can be used to indicate a reading that isabove the ideal range while a low tone can be used to indicate a readingthat is below. A pulsing or intermittent tone can be used to indicate areading that is in a range of high concern. A varying number of pulsesand other variations can be employed to indicate what range the analytereading is in. Similarly, a vibratory signal, such as used in cellphones, can be used with different variations for indicating alerts,alarms and reminders to a user.

According to various aspects of the invention, the above-describedalerts, alarms and reminders can be set with default parameters duringmanufacture, and/or may be settable by a HCP (Health Care Professionalsuch as a Doctor or Certified Diabetes Educator) with levelscorresponding to prescribed values for a user, and/or may be userconfigurable. In one embodiment of the invention, a meter is providedthat is set to automatically remind the user to retest after apredetermined period of time, which may be preset or configured, after atest that falls outside of an ideal analyte range. The meter may beconfigured to allow the user or healthcare professional to disable thisfeature. In an alternative embodiment, the meter is provided “out of thebox” with such a reminder feature disabled, but with provisions to allowthe user or healthcare professional to enable it and/or setconfiguration parameters. A meter can be provided that allows differentreminder parameters depending on whether the underlying analytemeasurement is in a range of moderate concern or a range of highconcern. In one embodiment, the medical device reminds the user with afirst audible signal to retest a first time period (e.g. about 30minutes) after a test result falling in a range of moderate concern, andreminds the user with a second audible signal to retest after a secondtime period (e.g. about 15 minutes) after a test result falling in arange of high concern. In certain embodiments, the second audible signalhas a higher volume level and/or longer duration than the first audiblesignal, and the second time period may be shorter than the first timeperiod. In this embodiment, the second audible signal can also beaccompanied with a vibratory signal. In this or alternative embodiments,the first and/or second signals can continue or repeat if notacknowledged by the user, such as with the push of a button, or with anactual test being conducted. The parameters of the reminders can also bedifferent based on whether the analyte reading is above or below theideal range, and/or can vary depending on the actual value of theanalyte measurement. For each reminder (alert or alarm) the settings mayinclude, but are not limited to, the analyte value, time to reminder,type of reminder (e.g. visual, audible, vibratory, or a combinationthereof), persistence of the reminder (e.g. once, once a minute for ntimes, or once a minute until acknowledged), and the number of times (n)a persistent reminder will repeat.

According to certain embodiments, a medical device can be provided withalert, alarm and reminder settings, or other healthcare information thatcan be configured and locked by an authorized individual such as anindividual in a supervisory role, e.g., a HCP or caregiver. Theinformation may be locked until an access code is supplied, such as byan authorized individual, e.g., a HCP or a caregiver. Such anarrangement prevents those under the care of a HCP from changing aprescription or those receiving guidance from a caregiver, for instancechildren, from modifying configuration values. This prevents intentionalor unintentional changes to the configuration values. It also preventsthe bypassing of alerts, alarms or reminders, such as when a user wantsto engage in behavior that may affect analyte levels, e.g., eatimproperly. According to other aspects, configuration settings may beset through a medical device data port, such as when the medical deviceis connected to a computer for the uploading and/or downloading ofinformation. In certain embodiments, a medical device may be configuredto enable a limited number of individuals, e.g., HCP and/or a caregiver,to set and lock configuration values through the data port.

Application of the inventive aspects described herein is not limited toblood glucose monitoring and/or insulin infusion. For example, analytesmay be monitored in other substances such as interstitial fluid.Moreover, monitoring of analytes other than glucose, such as lactate,acetyl choline, amylase, bilirubin, cholesterol, chorionic gonadotropin,creatine kinase (e.g., CK-MB), creatine, DNA, fructosamine, glucose,glutamine, growth hormones, hematocrit, hemoglobin (e.g. HbA1c),hormones, ketones, lactate, oxygen, peroxide, prostate-specific antigen,prothrombin, RNA, thyroid stimulating hormone, and troponin, in samplesof body fluid. Meters may also be configured to determine theconcentration of drugs, such as, for example, antibiotics (e.g.,gentamicin, vancomycin, and the like), digitoxin, digoxin, drugs ofabuse, theophylline, warfarin and the like. Such analytes can bemonitored in blood, interstitial fluid, saliva, urine and other bodilyfluids. It should also be noted that fewer or additional analytemeasurement ranges from those described herein can be used. Thisincludes not using ranges at all, but instead using, e.g., absolutevalues, formulas, lookup tables or similar concepts known to thoseskilled in the art to determine if or what type of alert, alarm,reminder or other indication should be made to the user for a particularanalyte measurement result.

BRIEF DESCRIPTION OF THE DRAWINGS

Each of the figures diagrammatically illustrates aspects of theinvention. Of these:

FIG. 1 is plan view showing an exemplary embodiment of an analytemonitoring system, such as a glucometer system, constructed according toaspects of the present invention;

FIG. 2 is a block diagram of an exemplary embodiment of an insulindelivery device;

FIG. 3 is a block diagram illustrating an exemplary embodiment of aninsulin therapy management system that incorporates the delivery deviceof FIG. 2 ;

FIG. 4 is a detail example of various alert and alarm displays, one ofwhich is shown in the system of FIG. 1 ;

FIG. 5 is a graph depicting an example of how the glucose level of auser might vary over the course of a portion of a day;

FIG. 6 is a graph depicting the glucose levels shown in FIG. 3 withtesting points added, some of which occur as a result of a reminder(alert or alarm);

FIGS. 7A and 7B show exemplary embodiments of a medical device withrestrictive user control;

FIG. 8 shows the medical device of FIG. 7B connected to an exemplaryembodiment of a data management system; and

FIG. 9 shows an exemplary embodiment of application software that mayrun on the data management system of FIG. 8 .

Variation of the invention from that shown in the figures iscontemplated.

DETAILED DESCRIPTION

The following description focuses on one variation of the presentinvention. The variation of the invention is to be taken as anon-limiting example. It is to be understood that the invention is notlimited to particular variation(s) set forth and may, of course, vary.Changes may be made to the invention described and equivalents may besubstituted (both presently known and future-developed) withoutdeparting from the true spirit and scope of the invention. In addition,modifications may be made to adapt a particular situation, material,composition of matter, process, process act(s) or step(s) to theobjective(s), spirit or scope of the present invention.

FIG. 1 shows a top view of an exemplary analyte medical system 10, e.g.,a glucometer system in this particular embodiment. Analyte medicaldevice 10 may be an electrochemical or optical system. System 10includes a handheld meter 12 and disposable test strip 14. Test strip 14can be inserted into or removed from test strip port 16 of meter 12 forphysical and electrical interconnection therewith. Meter 12 includes anLCD display 18 for displaying information to the meter user, and buttons20, 22 and 24 for receiving input from the user.

In general, to take a blood glucose measurement with meter 12, a userinserts a new test strip 14 into port 16 of meter 12. Either before ofafter strip insertion into the meter, a user then lances a fingertip orother part of the body (i.e. alternate site) to draw a small drop ofblood 26 to the surface of the skin. The meter and strip are positionedover the drop of blood 26 so that one of the sample chamber ends 28 istouching the drop of blood 26. While this particular example teaches theuse of a side-fill strip, it should be noted that an end-fill, top-fillor other type of test strip may be utilized. Moreover, the analytetesting need not use a test strip at all. For instance, certain testmeters may utilize a rotary test wheel for making multiple measurements,rather than individual test strips. In the present example, surfacetension (wicking) automatically draws a small amount of blood 26 intothe sample chamber and an electrochemical test is automaticallyperformed by meter 12 to determine the glucose concentration in theblood 26. The glucose level 30 is then displayed on meter 12. As notedabove, the subject invention is also applicable to continuous analytemonitoring systems and drug infusion devices.

The present invention may also find use with infusion systems forinfusing an agent to a user such as drug infusion systems, e.g., insulininfusion systems. Such infusion systems may be wholly implantablesystems or external systems. External infusion devices are typicallyconnected to an infusion set which includes a cannula that is placedtranscutaneously through the skin of the patient to infuse a selectdosage of an agent. For example, external insulin infusion devices aretypically connected to an infusion set which includes a cannula that isplaced transcutaneously through the skin of the patient to infuse aselect dosage of insulin based on the infusion device's programmed basalrates or any other infusion rates as prescribed by the patient's HCP. Auser may be able to control the insulin pump device to administeradditional doses of insulin during the course of wearing and operatingthe infusion device such as for, administering a carbohydrate bolusprior to a meal. Certain infusion devices may include a food databasethat has associated therewith, an amount of carbohydrate, so that thepatient may better estimate the level of insulin dosage needed for, forexample, calculating a bolus amount.

FIG. 2 is a block diagram of an exemplary embodiment of an insulindelivery for use with the present invention. Insulin delivery device 620in one embodiment includes a processor 710 operatively coupled to amemory unit 740, an input unit 720, a display unit 730, an output unit760, and a fluid delivery unit 750. In one embodiment, the processor 710includes a microprocessor that is configured for and capable ofcontrolling the functions of the insulin delivery device 620 bycontrolling and/or accessing each of the various components of theinsulin delivery device 620. In one embodiment, multiple processors maybe provided as safety measure and to provide redundancy in case of asingle processor failure. Moreover, processing capabilities may beshared between multiple processor units within the insulin deliverydevice 620 such that pump functions and/or control may be performedfaster and more accurately.

Input unit 720 operatively coupled to the processor 710 may include ajog dial, key pad buttons, a touch pad screen, or any other suitableinput mechanism for providing input commands to the insulin deliverydevice 620. More specifically, in case of a jog dial input device, or atouch pad screen, for example, the patient or user of the insulindelivery device 620 may manipulate the respective jog dial or touch padin conjunction with the display unit 730 which performs as both a datainput and output unit. The display unit 730 may include a touchsensitive screen, an LCD screen, or any other types of suitable displayunit for the insulin delivery device 620 that is configured to displayalphanumeric data as well as pictorial information such as iconsassociated with one or more predefined states of the insulin deliverydevice 620, or graphical representation of data such as trend charts andgraphs associated with the insulin infusion rates, trend data ofmonitored glucose levels over a period of time, or textual notificationto the patients.

Output unit 760 operatively coupled to the processor 710 may include anaudible alarm including one or more tones and/or preprogrammed orprogrammable tunes or audio clips, or vibratory alert features havingone or more pre-programmed or programmable vibratory alert levels. Inone embodiment, the vibratory alert may also assist in priming theinfusion tubing to minimize the potential for air or other undesirablematerial in the infusion tubing. Also shown is the fluid delivery unit750 which is operatively coupled to the processor 710 and configured todeliver the insulin doses or amounts to the patient from the insulinreservoir or any other types of suitable containment for insulin to bedelivered (not shown) in the insulin delivery device 620 via an infusionset coupled to a subcutaneously positioned cannula under the skin of thepatient.

Memory unit 740 may include one or more of a random access memory (RAM),read only memory (ROM), or any other types of data storage units that isconfigured to store data as well as program instructions for access bythe processor 710 and execution to control the insulin delivery device620 and/or to perform data processing based on data received from, e.g.,an analyte monitoring system 610, a remote terminal 640 (HCP orcaregiver), the patient 630 or any other data input source (see forexample FIG. 3 ).

FIG. 3 is a block diagram illustrating an insulin therapy managementsystem 600 that includes an insulin infusion device and an analytemonitoring system. The insulin therapy management system 600 includes ananalyte monitoring system 610 operatively coupled to an insulin deliverydevice 620, which may be in turn, be operatively coupled to a remoteterminal 640. Analyte monitoring system 610 is, in one embodiment,coupled to the patient 630 so as to monitor or measure the analytelevels of the patient. Moreover, the insulin delivery device 620 iscoupled to the patient using, for example, an infusion set and tubingconnected to a cannula (not shown) that is placed transcutaneouslythrough the skin of the patient so as to infuse medication such as, forexample, insulin, to the patient.

In one embodiment, the analyte monitoring system 610 may include one ormore analyte sensors subcutaneously positioned such that at least aportion of the analyte sensors are maintained in fluid contact with thepatient's analytes. The analyte sensors may include, but not limited toshort term subcutaneous analyte sensors or transdermal analyte sensors,for example, which are configured to detect analyte levels of a patientover a predetermined time period, and after which, a replacement of thesensors is necessary.

The one or more analyte sensors of the analyte monitoring system 610 iscoupled to a respective one or more of a data transmitter unit which isconfigured to receive one or more signals from the respective analytesensors corresponding to the detected analyte levels of the patient, andto transmit the information corresponding to the detected analyte levelsto a receiver device, and/or insulin delivery device 620. That is, overa communication link, the transmitter units may be configured totransmit data associated with the detected analyte levels periodically,and/or intermittently and repeatedly to one or more other devices suchas the insulin delivery device and/or the remote terminal 640 forfurther data processing and analysis. The transmitter units of theanalyte monitoring system 610 may be, in one embodiment, configured totransmit the analyte related data substantially in real time to theinsulin delivery device 620 and/or the remote terminal 640 afterreceiving it from the corresponding analyte sensors such that theanalyte level such as glucose level of the patient 630 may be monitoredin real time.

The transmitter units of the analyte monitoring system 610 may beconfigured to directly communicate with one or more of the remoteterminal 640 or the insulin delivery device 620. Furthermore, within thescope of the present invention, additional devices may be provided forcommunication in the insulin therapy management system 600 includingadditional receiver/data processing unit, remote terminals (such as aHCP terminal and/or a bedside terminal in a hospital environment, forexample).

The insulin delivery device 620 may include in one embodiment, but isnot limited to, an external infusion device such as an external insulininfusion pump, an implantable pump, a pen-type insulin injector device,a patch pump, an inhalable infusion device for nasal insulin delivery,or any other type of suitable delivery system.

In one embodiment, the analyte monitoring system 610 includes a stripport configured to receive a test strip for capillary blood glucosetesting. In one aspect, the glucose level measured using the test stripmay in addition, be configured to provide periodic calibration of theanalyte sensors of the analyte monitoring system 610 to assure andimprove the accuracy of the analyte levels detected by the analytesensors.

Exemplary in vitro and in vivo analyte monitoring system and druginfusion systems that may be adapted for the present invention include,but are not limited to, those described in U.S. Pat. Nos. 6,175,752;6,329,161; 6,284,478; 6,916,159; 7,041,468; 7,077,328, and U.S. patentapplication Ser. Nos. 11/383,945; 11/365,168; 11/386,915; 11/396,181;11/396,182, and elsewhere, the disclosures of which are hereinincorporated in their entirety by reference.

According to aspects of the present invention, an alert and/or alarm 32can also be shown on display 18 indicating, for example, whether thecurrent measurement falls within a predetermined range, such as an idealglucose range, an upper or lower range of moderate concern or an upperor lower range of high concern.

Referring now to FIG. 4 , a further example of alert and alarm displays32 is shown. A steeply downwardly inclined arrow 34 (e.g. from about −60to about −90 degrees) can be used to indicate a glucose reading in alower range of high concern, such as below 50 mg/dL. A moderatelydownwardly inclined arrow 36 (e.g. from about −30 to about −45 degrees)can be used to indicate a glucose reading in a lower range of moderateconcern, such as about 50 mg/dL to about 75 mg/dL. A horizontal arrow 38(e.g. about 0 degrees) can be used to indicate a glucose reading in anideal range, such as about 75 mg/dL to about 175 mg/dL. A moderatelyupwardly inclined arrow 40 (e.g. about 30 or about 45 degrees) can beused to indicate a glucose reading in an upper range of moderateconcern, such as about 175 mg/dL to about 250 mg/dL. Finally, a steeplyupwardly inclined arrow 42 (e.g. from about 60 to about 90 degrees) canbe used to indicate a glucose reading in an upper range of high concern,such as above about 250 mg/dL. As previously indicated above, variousother visual elements, and/or audible or physical indicators can be usedto provide the user with an alert or an alarm.

Referring now to FIG. 5 , an example of blood glucose values for a useris shown. Curve 100 depicts how the user's blood glucose might changewith time over a portion of a day. In this example, the ideal range forthe user is about 75 mg/dL to about 175 mg/dL, shown with referencenumeral 110 and bounded by dashed lines 112 and 114. The ranges ofmoderate concern are about 50 mg/dL to about 75 mg/dL (lower alert zone116, bounded by dashed lines 112 and 118) and about 175 mg/dL to about250 mg/dL (upper alert zone 120, bounded by dashed lines 114 and 122).The ranges of high concern are below about 50 mg/dL (lower alarm zone124, below dashed line 118) and above about 250 mg/dL (upper alarm zone126, above dashed line 122).

In FIG. 5 the glucose values (100) begin at about 150 mg/dL, rise toabout 195 mg/dL (101), fall to about 155 mg/dL (102), rise to about 270mg/dL (103), fall to about 60 mg/dL (104), rise to about 90 mg/dL (105),fall to about 40 mg/dL (106), and end at about 100 mg/dL.

FIG. 6 shows the same blood glucose values 100 as FIG. 5 but adds thetesting that was performed by that user, some of which occurs as aresult of a reminder (alert and/or alarm and/or reminder). For example,after a light meal (snack) the user tests with a reading of 193 mg/dL(201) that falls in the upper alert zone (120). This reading may causemeter 12 to generate an alert to the user, e.g., flashing display, beep,or the like, that his or her glucose is in an upper level of moderateconcern, as previously described above. The meter may alert the usersubstantially immediately after the determination of the reading in theupper alert zone, or sometime thereafter as described below. Regardlessof whether the user is notified substantially immediately of a readingin an alert zone (or other zone of concern as described herein), themeter may also be configured to remind the user to perform a re-testafter a predetermined amount of time following a reading in a zone ofimportance (alarm zone or alert zone). For example, after theabove-described meter reading in upper alert zone 120, a meter remindermay notify the user to perform a test after a predetermined amount oftime, e.g., about 5 minutes, e.g., about 10 minutes, e.g., about 20minutes, e.g., about 30 minutes, etc., and may periodically remind auser until a test is performed or until the reminder is cleared by theuser. For example, the user may respond to the reading and alert (ifalerted) with modest therapy and some time later (e.g., about 30minutes), a reminder prompts the user to test, resulting in a reading of160 mg/dL (202) that falls in the ideal zone (110).

Later, after a large meal the user tests with a reading of 268 mg/dL(203) that falls in the upper alarm zone (126). This reading causesmeter 12 to generate an alarm to the user that his or her glucose is inan upper level of high concern. The user responds to the reading with anappropriate therapy and some time later (e.g. 20 minutes), a reminderprompts the user to test, resulting in a reading of 232 mg/dL (204) thatfalls in the upper alert zone (120). This reading causes meter 12 togenerate an alert to the user that his or her glucose is in an upperlevel of moderate concern. The user may note that the previous therapywas appropriate and again, some time later (e.g. 30 minutes), a reminderprompts the user to test again, resulting in a reading of 156 mg/dL(205) that falls in the ideal zone (110) and confirms the previoustherapy was appropriate.

Still later, after having exercised but not having eaten the user feelsslightly symptomatic and tests with a reading of 61 mg/dL (206) thatfalls in the lower alert zone (116). This reading causes meter 12 togenerate an alert to the user that his or her glucose is in a lowerlevel of moderate concern. The user responds by eating a light meal(snack) and some time later (e.g. 25 minutes), a reminder prompts theuser to test, resulting in a reading of 81 mg/dL (207) that falls in theideal zone (110).

Yet later still, the user feels symptomatic and tests with a reading of41 mg/dL (208) that falls in the lower alarm zone (124). This readingcauses meter 12 to generate an alarm indicating that the glucose levelis in a lower level of high concern. The user responds by eating amodest meal and some time later (e.g. 15 minutes), a reminder promptsthe user to test, resulting in a reading of 63 mg/dL (209) that falls inthe lower alert zone (116). This reading causes meter 12 to generate analert indicating that the glucose level is now in a lower level ofmoderate concern. The user may note that the previous therapy (meal) wasappropriate or may eat a small amount (snack) and again some time later(e.g. 25 minutes), a reminder prompts the user to test, resulting in areading of 99 mg/dL (210) that falls in the ideal zone (110) andconfirms the course of therapy was appropriate.

It should be noted that in this example, tests 201, 203, 206 and 208were initiated by the user based on events known by the user to causechanges in blood glucose, or based on symptoms experienced by the user.More importantly, the user was prompted to perform tests 202, 204, 205,207, 209 and 210 by a meter constructed according to aspects of thepresent invention. These prompts or timed reminders assist the user inperforming appropriate tests in a timely manner. These tests in turnfacilitate the user's important goal of keeping his or her blood glucoselevel in the ideal zone 110 to maintain the user's short-term andlong-term health.

Embodiments also include supervisor-controllable, includingperson-restrictive (e.g., user-restrictive), medical devices.Configurations of a medical device may be settable and/or lockable by asupervisor (e.g., a HCP, parent or guardian, caregiver, or the like),e.g., remotely or by direct action (e.g., using a user interface of thedevice, or the like). For example, certain configurations of a medicaldevice may be settable and/or lockable by a first person (e.g., a HCP)having a first access level (e.g., full access such as full Read/Writepermission) and certain configurations that may be settable and/orlockable by a second person (e.g., a caregiver) having a second accesslevel (e.g., limited Read/Write permission). The medical device may besettable and/or lockable by a third person (e.g., a user under thesupervision of the first and second persons) having a third access level(e.g., further limited, e.g., Read only—including no rights to modifypreviously inputted data). Any number of persons may have certain orlimited access rights to a medical device. For example, certainembodiments include medical devices having certain configurationssettable and/or lockable by a HCP and certain other features settableand/or lockable by a caregiver. A user may be completely restricted frommodifying the configurations set by the HCP and/or caregiver.

Configurations may be access controlled with an access code (e.g.,password protected, voice authentication, USB token protected, or othermanner of authenticating a user) to allow access permissions for aspecific individual, medical device, computer, or group of individuals.When permission is set, the type and level of access granted to anindividual, computer, or group is granted. For example, various degreesof, e.g., Read and Write and View permissions may be granted todifferent persons, as described above.

Different codes may provide different rights. For example an HCP codemay enable a HCP to enter prescriptive information and/or delete and/ormodify stored prescriptive (“Rx”) information, where prescriptiveinformation is broadly defined relevant information prescribed by a HCP.Prescriptive information may include patient-specific data and mayinclude but is not limited to, one or a plurality of basal rates,insulin ideal analyte ranges, alert and alarm thresholds, medicationtype (e.g., insulin type), medication dose including total daily dose(e.g., total daily insulin dosage), drug sensitivity (e.g., insulinsensitivity), when to take a medication, how to take a medication, whento treat a condition, how to treat a condition, when to elevate concernsto a HCP or caregiver, reminder schemes (e.g., setting times ofreminders), etc. The above is not an exhaustive list, e.g., for treatingdiabetes, information may also include insulin/carbohydrate information,and other relevant information. In this manner, a medical device may becustomizable by a HCP to include user-specific prescriptive information,some of which may not relate to values or settings in the medical devicebut may be made available for reference purposes only (e.g., as a textnote such as those commonly displayed on a PDA, or the like). A medicaldevice may be lockable by a HCP, who may also set access levels forothers such as for a caregiver and/or user. In this manner, a HCP (orother designated individual) may serve as the “Administrator” having theability to control access at a granular level, establishing accesslevels on a person-by-person basis.

In addition to, or instead of HCP provided configurations, a caregivermay also enter and/or lock configurations of a medical device. In manyembodiments, at least some of the configurations under caregiver controldiffer at least in part from configurations reserved for HCP control,which would be prescriptive in nature, as described above. Caregiveraccess may enable a caregiver to enter caregiver information and/ordelete and/or modify stored caregiver information. Caregiver informationincludes, but is not limited to the ability to set and lock any value oruser restriction not previously set and locked by the HCP such asnon-prescriptive alarm values, user menu access, and other userprivileges such as data transfer (e.g., upload to a PC) and storageoptions (e.g., read-only or read-write access to various data). Forexample, a HCP may set and lock values and allowed options (e.g., lockmenus). The caregiver access allowed by the HCP can set and lock thatwhich the HCP did not lock. Caregiver access may provide the caregiverwith the ability to lock and/or unlock user features, such as providingthe user with increased access over time as the user begins tounderstand and appreciate the subtleties and complexities of variousfeatures (e.g., setting correct values such as alarm thresholds andreminder time values or accessing menus that show information that mightbe confusing if not interpreted properly). Similarly, the user may beable to access that allowed by the caregiver (and HCP), and may be ableto set that which is not locked.

The configurations may be set and/or locked by inputting data directlyinto the medical device using, e.g., a user interface, or may beaccomplished indirectly including remotely, e.g., via a computer systemconnected to a network, where a network represents any uni- orbi-directional communication link suitable for communicating data, suchas a wide-area network, local area network, or a global computer networklike the World Wide Web (“the Web”). Accordingly, embodiments include aweb-based data management system that allows persons to controllablyaccess and/or manipulate and/or share information, depending on a givenperson's permission level. Each HCP and/or caregiver and/or medicaldevice user may interact with a computing device suitable for accessingthe data management system via a network. For example, a personalcomputer, laptop computer, phone such as a cellular telephone, apersonal digital assistant (PDA), etc., may be used. The communicationdevice typically executes communication software, typically a webbrowser such as INTERNET EXPLORER from Microsoft Corporation of Redmond,Wash., or the like, in order to communicate with the data managementsystem.

Once configurations are set, e.g., by a HCP, caregiver or user, thestored information may be employed by the medical device in theexecution of healthcare management, e.g., glucose monitoring. The storedinformation may be conveyed to a user in audible format and/or visualand/or tactile format. For example, prescriptive information inputted bya HCP may be visually displayed on the display of a medical device,e.g., as an icon (e.g., an “Rx” icon, as a note (similar to displayedPDF notes), or the like), or may be in audible or tactile form.

FIG. 7A shows the hierarchal permission scheme of an embodiment of amedical device 300 having restrictive control, e.g., restrictivecaregiver and user control. The most critical settings and portions ofthe user interface (e.g. the ability to set values and activate menuitems) may be set by a HCP. Values that must be prescribed by a HCP arein the HCP Only portion of the user interface as bounded by the dashedline 310. Additional values prescribed by the HCP are included in theHCP settings region 320 as bounded by the solid line 330. For example,the HCP may restrict access to various options and menus (e.g., datatransfer and storage parameters) and may set and lock various valuessuch as, for example, the lower threshold for high concern and theassociated alarm parameters. A caregiver (e.g. a parent) may setadditional restrictions by the Caregiver settings region 340 as boundedby the solid line 350. For example, the caregiver may set and lock thepreviously unlocked upper threshold for high concern and the associatedalarm parameters and set preferred values for other threshold and theassociated alarm parameters without locking those values (i.e., the usermay update those values at a later time). Finally, the user of themedical device is allowed access to the User Allowed portion of the userinterface as bounded by the dashed line 360 along with a portion of theuser interface that is always allowed, which is included in the Userregion 370 of the user interface.

FIG. 7B shows medical device 300 of FIG. 7A, but in this embodimentsthere is no caregiver and the User region 370 includes of all portionsof the user interface that are not restricted by the HCP in the HCPsettings region 320.

FIG. 8 shows medical device 300 as connected to a Data Management System(DMS) 400 through connection 410 which may be wired or wireless. The DMS400 may interface too many medical devices where only one is shown, andeach may be of similar or differing types (e.g. analyte meter (such as ablood glucose meter), continuous analyte monitor (such as a continuousglucose monitor), or drug infusion pump (such as an insulin pump)).

FIG. 9 shows application software (SW) that runs on the DMS 400 wherethe DMS Application SW 500 interfaces to the medical device (not shown)via connection 410. SW 500 may be embodied on a computer readablemedium. The DMS Application SW 500 also interfaces to the HCPApplication SW 510, the Caregiver Application SW 520, and the UserApplication SW 530 through SW connections 540, 550 and 560 respectively.Each of the HCP, Caregiver and User Application SW modules has the samerestrictive user controls (e.g. privileges and restrictions) to thosethat are set directly on the medical device while allowing a morecomplete user interface, such as a Graphical User Interface (GUI) suchas those commonly found on PC computers. Additional features availableonly on the DMS 400 through the GUI (e.g. advanced data graphingfeatures) may also be subject to similar restrictive user controls asdescribed for the medical device.

As for additional details pertinent to the present invention, materialsand manufacturing techniques may be employed as within the level ofthose with skill in the relevant art. The same may hold true withrespect to method-based aspects of the invention in terms of additionalacts commonly or logically employed. Also, it is contemplated that anyoptional feature of the inventive variations described may be set forthand claimed independently, or in combination with any one or more of thefeatures described herein. Likewise, reference to a singular item,includes the possibility that there are plural of the same itemspresent. More specifically, as used herein and in the appended claims,the singular forms “a,” “an,” “said,” and “the” include plural referentsunless the context clearly dictates otherwise. It is further noted thatthe claims may be drafted to exclude any optional element. As such, thisstatement is intended to serve as antecedent basis for use of suchexclusive terminology as “solely,” “only” and the like in connectionwith the recitation of claim elements, or use of a “negative”limitation. Unless defined otherwise herein, all technical andscientific terms used herein have the same meaning as commonlyunderstood by one of ordinary skill in the art to which this inventionbelongs. The breadth of the present invention is not to be limited bythe subject specification, but rather only by the plain meaning of theclaim terms employed.

The invention claimed is:
 1. A medical device comprising: one or moreprocessors; a memory unit operatively coupled to the one or moreprocessors and including program instructions stored therein which, whenexecuted by the one or more processors, causes the one or moreprocessors to: receive, from a first device, a first configuration ofthe medical device, wherein the first device is associated with a firstpermission to configure the medical device, wherein the firstconfiguration identifies first access level rights and second accesslevel rights, wherein the first access level rights enable a firstindividual to view first level parameters of a plurality of parametersof the medical device, wherein the first configuration furtheridentifies first settings for the first level parameters of theplurality of parameters, and wherein the second access level rightsenable a second individual to view second level parameters of theplurality of parameters using the medical device, the second levelparameters being different than the first level parameters; configurethe medical device with the first configuration; transmit the firstlevel parameters to the first device associated with the firstindividual; and transmit the second level parameters to a second deviceassociated with the second individual.
 2. The medical device of claim 1,wherein the medical device is in data communication with an in vivoanalyte sensor.
 3. The medical device of claim 2, wherein the in vivoanalyte sensor is an in vivo continuous glucose sensor.
 4. The medicaldevice of claim 1, wherein the first level parameters comprises a firstvisual representation of glucose information from the medical device andthe second level parameters comprises a second visual representation ofthe glucose information from the medical device, wherein the firstvisual representation is different from the second visualrepresentation.
 5. The medical device of claim 4, wherein the firstvisual representation of glucose information comprises a first glucosetrend chart and the second visual representation of the glucoseinformation comprise a second trend chart.
 6. The medical device ofclaim 1, wherein the first access level rights enable a first individualto modify, set, or lock first level parameters of the plurality ofparameters of the medical device, and wherein the first level parametersinclude at least prescriptive parameters.
 7. The medical device of claim6, wherein the prescriptive parameters include one or more of a basalrate, a target analyte range, an alert or alarm threshold, a medicationtype, a medication dose, a total daily medication dose, a drugsensitivity, a parameter associated with when to take mediation, aparameter associated with how to take medication, a parameter associatedwith when to treat a health condition, a parameter associated with howto treat the health condition, and a reminder scheme.
 8. The medicaldevice of claim 1, wherein the second access level rights enable asecond individual to set, modify, or lock second level parameters of theplurality of parameters using the medical device, the second levelparameters at least being different than first level parameters lockedby the first individual, and wherein the second level parameters includeat least non-prescriptive parameters.
 9. The medical device of claim 8,wherein the non-prescriptive parameters include one or more of an alarmvalue, a user menu access parameter, a data transfer and storageparameter, and a reminder associated therewith.
 10. The medical deviceof claim 1, wherein the program instructions, when executed by the oneor more processors, further causes the one or more processors to:receive, from the second device, a second configuration of the medicaldevice, wherein the second device is associated with a second permissionto configure the medical device, wherein the first permission isdifferent from the second permission, and wherein the secondconfiguration is different from the first configuration, and wherein thesecond configuration identifies second settings for the second levelparameters of the plurality of parameters; and configure the medicaldevice with the second configuration.
 11. A method comprising:receiving, by a medical device and from a first device, a firstconfiguration of the medical device, wherein the first configurationincludes an access level hierarchy comprising at least first accesslevel rights and second access level rights, wherein the first accesslevel rights enable a first individual to view first level parameters ofa plurality of parameters of the medical device, wherein the firstconfiguration identifies first settings for the first level parametersof the plurality of parameters, and wherein the second access levelrights enable a second individual to view second level parameters of theplurality of parameters using the medical device, the second levelparameters being different than the first level parameters; configuringthe medical device with the access level hierarchy; transmitting thefirst level parameters to the first device associated with the firstindividual; and transmitting the second level parameters to a seconddevice associated with the second individual.
 12. The method of claim11, further comprising configuring the medical device to be in datacommunication with an in vivo analyte sensor.
 13. The method of claim12, wherein the in vivo analyte sensor is an in vivo continuous glucosesensor.
 14. The method of claim 11, wherein the first level parameterscomprises a first visual representation of glucose information from themedical device and the second level parameters comprises a second visualrepresentation of the glucose information from the medical device,wherein the first visual representation is different from the secondvisual representation.
 15. The method of claim 14, wherein the firstvisual representation of glucose information comprises a first glucosetrend chart and the second visual representation of the glucoseinformation comprise a second trend chart.
 16. The method of claim 11,wherein the first level parameters include at least prescriptiveparameters.
 17. The method of claim 16, wherein the prescriptiveparameters include one or more of a basal rate, a target analyte range,an alert or alarm threshold, a medication type, a medication dose, atotal daily medication dose, a drug sensitivity, a parameter associatedwith when to take mediation, a parameter associated with how to takemedication, a parameter associated with when to treat a healthcondition, a parameter associated with how to treat the healthcondition, and a reminder scheme.
 18. The method of claim 11, whereinthe second level parameters include at least non-prescriptiveparameters.
 19. The method of claim 18, wherein the non-prescriptiveparameters include one or more of an alarm value, a user menu accessparameter, a data transfer and storage parameter, and a reminderassociated therewith.
 20. The method of claim 18, wherein the secondlevel parameters further include prescriptive parameters that have notbeen locked by the first individual.
 21. The method of claim 11, furthercomprising: receiving, from the second device, a second configuration ofthe medical device, wherein the second device is associated with asecond permission to configure the medical device, wherein a firstpermission associated with the first device is different from the secondpermission, and wherein the second configuration is different from thefirst configuration, and wherein the second configuration includessecond settings for the second level parameters of the plurality ofparameters; and configuring the medical device with the secondconfiguration.